title: Avoidable deaths still occur after large bowel surgery. Scottish Audit of Surgical Mortality, Royal College of Surgeons of Edinburgh.
abstract: BACKGROUND
  Postoperative death following large bowel surgery is relatively infrequent and no large study has analysed the cause of all deaths comprehensively and critically.
  
  
  METHODS
  In-hospital deaths following large bowel surgery in South-East Scotland were reviewed by independent assessors. The audit was confidential but not anonymous. Independent assessors' reports were returned to consultants.
  
  
  RESULTS
  The audit documented 187 deaths. The independent assessors noted an adverse event in 78 patients (42 per cent). Twenty-six deaths (14 per cent) occurred following an anastomotic leak. A further 43 deaths (23 per cent) occurred because surgery was delayed (17) or there was undue delay in making the initial diagnosis (12) or recognizing a developing complication (14). Consultants operated on only half the patients classed as American Society of Anesthesiologists grade IV or V, or undergoing a second or subsequent operation.
  
  
  CONCLUSIONS
  Half the patients dying in this study had identifiable deficiencies in their management. There is a clear need for greater consultant input with critically ill patients.
authors.affiliation: Department of Surgery, Eastern General Hospital, Edinburgh, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Macarthur
authors.forename: S J
authors.initials: SJ
authors.lastname: Nixon
authors.forename: R J
authors.initials: RJ
authors.lastname: Aitken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D003108:Colonic Diseases / Q000401:mortality* / Q000601:surgery*; D003107:Colorectal Surgery; D003657:Decision Making; D003951:Diagnostic Errors; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010865:Pilot Projects; D012606:Scotland / Q000453:epidemiology; D013529:Surgical Wound Dehiscence / Q000401:mortality